MEDICARE: TAM TRUONG, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1104693118
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAM TRUONG, LLC

Provider Business Mailing Address
First Line	:	5055 SUNDROP WAY
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-6182
Country	:	US
Telephone Number	:	714-234-1071
Fax Number	:

Provider Business Practice Location Address
First Line	:	5310 TIMUQUANA RD # 8049
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-8049
Country	:	US
Telephone Number	:	904-771-0933
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TAM TRUONG
Credential	:	DMD
Telephone Number	:	714-234-1071

Provider Enumeration Date	:	12/08/2023
Last Update Date	:	12/08/2023

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Directions to “TAM TRUONG, LLC ” Practice Location

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